Silent Killers: Counterfeit Drugs in Somalia While the global trade in counterfeit, falsified, and adulterated pharmaceuticals has proven difficult to trace, it has been estimated to be worth as much as USD 200 billion annually. Produced en masse and smuggled through complex transnational criminal networks, the majority of the world's counterfeit drugs are believed to originate in China and India before dispersing across the globe. The issue is especially acute in Africa, where falsified and substandard medicines have been estimated by the UN Office on Drugs and Crime to contribute to up to 500,000 deaths in the sub-Saharan region every year. And Somalia, in particular, faces a grim confluence of problems stemming from the lack of regulation in its pharmaceutical industry, a partial legacy of the collapse of the state in the 1990s. But with the sector intimately connected to transnational smuggling, attempts to tackle the booming trade have toiled in the face of entrenched corruption, porous borders, and weak regulatory oversight.